Wed, 19 Mar 2003

Treating children's simple eye injuries

Donya Betancourt, Pediatrician,

Eye injuries, such as black eyes, damage done to the cornea and getting chemicals or foreign objects in the eye, and simple first aid for these problems are what we will discuss today.

Let's start with black eyes. In medical terms this is called ecchymosis, or bruising of the eyes. The black eye usually occurs from some type of trauma, causing the tissue around the eye to become bruised.

Most black eyes heal completely and do not cause any permanent damage. Treatment includes applying cold compresses to the eye for the first 24 hours and warm compresses afterward. You should continue applying compresses until the swelling stops. The child's head should stay elevated to help decrease the amount of swelling.

Bruising may appear to spread or go down the cheek or to the other eye, but this is normal. Consult your child's doctor to make sure no damage was done to the eye.

The next common type of eye injury involves the cornea, which is the clear, protective "window" at the front of the eye. The cornea can become scratched or cut from contact with dust, dirt, or sand. This is called a corneal abrasion.

Some corneal abrasions become infected and result in a corneal ulcer, which is a serious problem. Everyday activities can lead to corneal abrasions. Examples are playing sports, or being scratched by a fingernail.

Since the cornea is extremely sensitive, abrasions can be painful. If the cornea is scratched, your child might feel like there is sand in the eye. Tears, blurred vision, sensitivity or redness around the eye can suggest a corneal abrasion.

In case of injury, seek prompt medical attention. The immediate steps you can take are to run water over the eye or splash the eye with clean water. Rinsing the eye may wash out the offending foreign body. Tell your child to blink several times. This movement may remove small particles of dust or sand. Pull the upper eyelid over the lower eyelid. The lashes of the lower eyelid can brush the foreign body from under the surface of the upper eyelid.

Take caution to avoid certain actions that may aggravate the injury such as applying patches or ice packs to the eye. If you do get an object within the eye, avoid rubbing the eye.

Another common injury to the cornea is a splash accident such as contact with chemicals. If a chemical splashes into your child's eye, flush it with water immediately. Any source of clean drinking water will do. It is most important to begin flushing. Flushing water may dilute the chemical.

Continue to flush the eye for at least 20 minutes, particularly if your eye is exposed to household cleaners that contain ammonia. After washing the eye thoroughly, close the eyelid and cover it with a loose, moist dressing. Then seek emergency medical assistance.

If your child gets a foreign object in the eye first tell him or her to keep their hands away from the eye, then wash your hands before you examine the eye. You can look for foreign objects by gently pulling the lower lid downward and instructing your child to look upward. Reverse the procedure for the upper lid. Hold the upper lid and examine the eye while the child looks downward. If you find that the object is embedded in the eyeball, cover the child's eye with a sterile pad or a clean cloth. Don't try to remove the object.

If the object is large and makes closing the eye difficult, cover the eye and the object with a paper cup. Don't remove the object. Seek emergency medical assistance.

If the object is floating in the tear film or on the surface of the eye, you may be able to flush it out or remove it manually. While holding the upper or lower lid open, use a moistened cotton swab or the corner of a clean cloth to remove the object by lightly touching it. If you do remove the object and pain, vision problems or redness persists, flush the eye with a saline solution or lukewarm water, cover both eyes with a soft cloth and seek emergency medical assistance.